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Mechanical thrombectomy in patients with acute ischemic stroke: A cost-effectiveness and value of implementation analysis

Heggie, R; Wu, O; White, P; Ford, GA; Wardlaw, J; Brown, MM; Clifton, A; (2019) Mechanical thrombectomy in patients with acute ischemic stroke: A cost-effectiveness and value of implementation analysis. International Journal of Stroke 10.1177/1747493019879656. (In press). Green open access

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Abstract

BACKGROUND Recent clinical trials have demonstrated the efficacy of mechanical thrombectomy in acute ischemic stroke. AIMS To determine the cost-effectiveness, value of future research, and value of implementation of mechanical thrombectomy. METHODS Using UK clinical and cost data from the Pragmatic Ischemic Stroke Thrombectomy Evaluation (PISTE) trial, we estimated the cost-effectiveness of mechanical thrombectomy over time horizons of 90-days and lifetime, based on a decision-analytic model, using all existing evidence. We performed a meta-analysis of seven clinical trials to estimate treatment effects. We used sensitivity analysis to address uncertainty. Value of implementation analysis was used to estimate the potential value of additional implementation activities to support routine delivery of mechanical thrombectomy. RESULTS Over the trial period (90 days), compared with best medical care alone, mechanical thrombectomy incurred an incremental cost of £5207 and 0.025 gain in QALY (incremental cost-effectiveness ratio (ICER) £205,279), which would not be considered cost-effective. However, mechanical thrombectomy was shown to be cost-effective over a lifetime horizon, with an ICER of £3466 per QALY gained. The expected value of perfect information per patient eligible for mechanical thrombectomy in the UK is estimated at £3178. The expected value of full implementation of mechanical thrombectomy is estimated at £1.3 billion over five years. CONCLUSION Mechanical thrombectomy was cost-effective compared with best medical care alone over a patient’s lifetime. On the assumption of 30% implementation being achieved throughout the UK healthcare system, we estimate that the population health benefits obtained from this treatment are greater than the cost of implementation.

Type: Article
Title: Mechanical thrombectomy in patients with acute ischemic stroke: A cost-effectiveness and value of implementation analysis
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1177/1747493019879656
Publisher version: https://doi.org/10.1177/1747493019879656
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Mechanical thrombectomy, budget impact, cost-effectiveness, implementation
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology
URI: https://discovery-pp.ucl.ac.uk/id/eprint/10086519
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